Recurrent arteriovenous malformation on palate after embolization combined surgical resection: preoperative magnetic resonance features and intraoperative angiographic findings

Abstract

Angiography is the gold standard for the diagnosis and complete resection of arteriovenous malformations (AVMs). The absence of residual AVM after surgery is commonly believed to reduce the risk of future hemorrhage. However, AVMs can recur after proven complete angiographic resection can occur, albeit rarely, especially in the pediatric population. We report a rare case of a recurrent AVM two years after complete resection in an adult patient. This case report shows that AVMs in adults can recur despite their rarity and despite postoperative angiography confirming complete removal. Moreover, in this case, the recurrent AVM involved a new feeding vessel that was not involved with the initial lesion.

Keywords: Angiography; Arteriovenous malformations; Palate; Recurrence; Resection.

Figure. 1

A. Preoperative photograph shows left palatal swelling and ulceration. B, C. Dental panorama and computed tomography reveal no definite cortical bone resorption or specific lesion.

Figure. 2

Preoperative axial T1-weighted (A) and T2-weighted (B) magnetic resonance images show a high-intensity mass on the left palate. Coronal T1-weighted images (C, D) reveal that the lesion did not involve the maxilla.

Figure. 3

A, B. Preoperative left carotid angiogram show an arteriovenous malformation in the left palate (circles). This lesion is supplied by the descending palatine artery (C, arrow) and drained through a facial vein (D, arrow).

Figure. 4

Unilateral external carotid angiogram obtained immediately after embolization shows devascularization of the left palatal lesion (dotted circle).

Figure. 5

Photograph (A) and left carotid angiogram (B) 31 months after the initial operation, show a recurrent lesion on the left palate.